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Nutrition And Type 2 Diabetes
Type 2 (Adult Onset) Diabetes by Tracy S Gates
Symptoms of Diabetes
Type 2 diabetes is frequently diagnosed in aymptomatic patients during a routine medical examination. Symptoms of diabetes include:
Late complications of diabetes include: heart disease, infections, skin ulcers, kidney disease, numbness and tingling in the hands and feet, impotence, constipation, pain and poor circulation in the legs, vision loss.
The relationship between eating carbohydrates and type 2 diabetes is complex. While eating carbohydrates increases the need for insulin to keep blood sugar normal, diets high in total carbohydrates do not necessarily increase the risk of type 2 diabetes. Researchers have found that diets very high in sugar may worsen glucose tolerance in nondiabetic animals and humans. However, the amount of sugar used in these studies in proportion to other foods was much larger than is typically found in human diets.
Eating carbohydrate-containing foods, whether high in sugar or high in starch (such as bread, potatoes, processed breakfast cereals, and rice) will temporarily raise blood sugar and insulin levels. The blood sugar–raising effect of a food - its “glycaemic index” - depends on how rapidly its carbohydrate is absorbed. Many starchy foods have a glycaemic index similar to table sugar (sucrose). People eating large amounts of foods with high glycaemic indexes have been reported to be at increased risk of type 2 diabetes. On the other hand, eating a diet high in carbohydrate-rich foods with low glycaemic indexes is associated with a low risk of type 2 diabetes. Beans, peas, fruit, and oats have low glycaemic indexes, despite their high carbohydrate content, due mostly to the health-promoting effects of soluble fibre.
Diabetes disrupts the mechanisms by which the body controls blood sugar. Until recently, health professionals have recommended sugar restriction to people with diabetes, even though short-term high-sugar diets have been shown, in some studies, not to cause blood sugar problems in people with diabetes. Currently, the British Diabetic Association (BDA) guidelines do not prohibit the use of moderate amounts of sugar, as long as blood levels of glucose, triglycerides, and cholesterol are maintained within normal levels.
Most doctors recommend that people with diabetes reduce the amount of sugar eaten in snacks and processed foods, and replace these foods with high-fibre, whole foods. This tends to lower the glycaemic index of the overall diet and has the additional benefit of increasing vitamin, mineral, and fibre intake.
A high-fibre diet has been shown to work better in controlling diabetes than the diet recommended by the BDA, and may control blood sugar levels as well as oral diabetes drugs. In this study, the increase in dietary fibre was accomplished exclusively by eating foods naturally high in fibre—such as leafy green vegetables, porridge and fruit—to a level beyond that recommended by the BDA. No fibre supplements were given. All participants received both the BDA diet (providing 24 grams of fibre per day) and the high-fibre diet (providing 50 grams of fibre per day) for a period of six weeks. After six weeks of following each diet, tests were performed to determine blood glucose, insulin, cholesterol, triglyceride, and other values. When glucose levels were monitored over a 24-hour period, participants eating the high-fibre diet had an average glucose level that was 10% lower than participants eating the BDA diet. Insulin levels were 12% lower in the group eating the high-fibre diet compared to the group eating the BDA diet, indicating a beneficial increase in the body’s insulin sensitivity. Moreover, people eating the high-fibre diet experienced significant reductions in total cholesterol, triglycerides, and LDL cholesterol compared with those eating the BDA diet. They also had slight decreases (improvements) in glycosylated haemoglobin levels - a measure of long-term blood glucose regulation.
High-fibre supplements, such as psyllium, guar gum (found in cluster beans), pectin (from fruit), oat bran, and glucomannan, have improved glucose tolerance in some studies. Positive results have also been reported with the consumption of 1 to 3 ounces of powdered fenugreek seeds per day.
Eating fish also may afford some protection from diabetes. Incorporating a fish meal into a weight-loss regimen was more effective than either measure alone at improving glucose and insulin metabolism and high cholesterol.
Vegetarians have been reported to have a low risk of type 2 diabetes. When people with diabetic neurological damage switch to a vegan diet (no meat, dairy, or eggs), improvements have been reported after several days. In one trial, pain completely disappeared in 17 of 21 people. Fats from meat and dairy may also contribute to cardiovascular disease, the leading killer of people with diabetes.
Vegetarians also eat less protein than do meat eaters. Reducing protein in the diet has lowered kidney damage caused by diabetes and improved glucose tolerance.
Diets high in fat, especially saturated fat, worsen glucose tolerance and increase the risk of type 2 diabetes, an effect that is not simply the result of weight gain caused by eating high-fat foods. Saturated fat is found primarily in meat, dairy fat and the dark meat and skins of poultry. In contrast, glucose intolerance has been improved by diets high in mono-unsaturated oils, which may be good for people with diabetes. The best way to incorporate mono-unsaturates into the diet is to use olive oil, especially extra virgin olive oil, which has high antioxidant values.
Most people with type 2 diabetes are overweight. Excess abdominal weight does not stop insulin formation, but it does make the body less sensitive to insulin. Excess weight can even make healthy people prediabetic, though weight loss can reverse this problem. In most studies, type 2 diabetes has improved with weight loss.
Exercise helps to decrease body fat and improve insulin sensitivity. People who exercise are less likely to develop type 2 diabetes than those who do not. However, exercise can induce low blood sugar in diabetics taking blood sugar–lowering medications, so blood sugars need to be carefully monitored when commencing an exercise programme.
Moderate alcohol drinking in healthy people improves glucose tolerance. However, alcohol has been reported to worsen glucose tolerance in the elderly and in people with diabetes in some studies. People with diabetes who drink have also been reported to have a high risk for eye and neurological damage.
For healthy people, light drinking will not increase the risk of diabetes, and may even reduce the risk of developing type 2 diabetes; however, heavy drinking does increase the risk of developing diabetes and should be avoided. People with diabetes should limit alcohol intake to two drinks per day. In one report, older people with type 2 diabetes who drank daily, but moderately, had a dramatically lower incidence of deaths from cardiovascular disease compared with non-drinkers. This outcome is not surprising since moderate alcohol intake is associated with protection from cardiovascular disease in most other reports. This finding may be of particular importance because cardiovascular disease is the leading killer of people with diabetes.
People with diabetes who smoke are at higher risk for kidney damage, cardiovascular disease and other diabetes-linked problems. Smokers are also more likely to develop diabetes.
Although most healthcare professionals agree on the necessity of self-monitoring of blood glucose (SMBG) by people with type 1 diabetes, disagreement exists within the medical community regarding the efficacy and necessity of SMBG by people with type 2 diabetes. Nevertheless, it is likely that self-monitoring of blood glucose, if used properly, can have a positive effect by increasing a person's involvement in overall diabetes care.
Nutritional Supplement Treatment Options
A variety of vitamins, minerals, amino acids, and other supplements may help with symptoms and deficiencies associated with diabetes.
Multiple Vitamin–Mineral Supplement
The typical amount of chromium used in research trials is 200 mcg per day, although as much as 1,000 mcg per day has been used.
*Supplementation with chromium or brewer’s yeast could potentially enhance the effects of drugs used for diabetes (e.g., insulin or other blood sugar-lowering agents) and possibly lead to hypoglycemia. Therefore, people with diabetes taking these medications should supplement with chromium or brewer’s yeast only under the supervision of a doctor.
Alpha lipoic acid
Evening primrose oil
Glycosylation is an important measurement of diabetes; it refers to how much sugar attaches abnormally to proteins. Excessive glycosylation appears to be one of the causes of the organ damage that occurs in diabetes. Vitamin E supplementation has reduced the amount of glycosylation in repeated studies.
Vitamin E appears to lower the risk of cerebral infarction in people with diabetes who smoke.
Biotin is a B vitamin required for glucose metabolism. When people with type 2 diabetes were given 9 mg of biotin per day for two months, their fasting glucose levels dropped dramatically. Biotin may also reduce pain from diabetic neurological damage.
Vitamin B12 is needed for normal functioning of neurons. Vitamin B12 taken orally has reduced symptoms of neurological damage caused by diabetes in 39% of people studied; when given both IV and orally, two-thirds of people improved. Oral vitamin B12 up to 500 mcg TID is recommended by some practitioners.
500 to 750 mg per day of niacin for one month followed by 250 mg per day may help some people with type 2 diabetes, although this research remains preliminary.
Botanical Treatment Options
Several herbs may help in managing symptoms associated with diabetes, including the control of blood sugar levels.
Acupuncture may be helpful in the treatment of diabetes, or complications associated with diabetes. Preliminary trials have suggested that acupuncture can lower blood sugar and improve insulin production in people with type 2 diabetes, but trials on long-term effects have not been concluded. In a preliminary trial, 77% of people suffering from diabetic neuropathy experienced significant reduction in pain following up to six acupuncture treatments over a ten-week period. Many were also able to reduce pain medications, but no long-term change in blood-sugar control was observed. Bladder control problems, a complication of long-term diabetes, responded to acupuncture treatment with a significant reduction in symptoms in both controlled and uncontrolled trials.